| Objective Establishing theoretical support for the prognosis of circulating tumor cells in advanced gastric cancer by Meta-analysis.To detect the expression status of mesenchymal circulating tumor cells in patients with advanced gastric cancer and evaluate the chemotherapeutic efficacy and prognostic in patients with advanced gastric cancer.To provide a basis for the clinical application of I-CTC in patients with advanced gastric cancer.Methods Cohort studies on the relationship between CTC and gastric cancer prognosis were searched through databases such as Embase,Cochrane,Pubmed,Wan Fang Data,CNKI and VIP.The time period was until December 26,2021.Two researchers independently screened the literature,independently extracted information from the data and performed risk of literature bias inclusion.Revman software(Review Manager version 5.4)was used for data analysis.To retrospectively analyze 59 patients with locally progressive gastric cancer treated at the General Surgery Clinical Medical Center of Gansu Provincial Hospital between October 2019 and October 2020.Detecting the expression level of I-CTC and following up the survival of patients.The ROC curve was plotted to determine the optimal cut-off value for I-CTC expression levels.Based on this cut-off value,59 gastric cancer patients were grouped into positive and negative groups.The differences in clinicopathological characteristics between the two groups were analyzed.Patient survival was followed up and recorded until October 2022.Plotting survival curves and performing univariate and multifactorial analyses of patient prognostic factors.Methods The Kaplan-Meier method and Cox regression model were used,respectively.To investigate the factors affecting postoperative survival of patients with locally progressive gastric cancer.Results A total of 14 retrospective cohort studies with 1053 patients were included.The results showed that the overall survival time(OS)and progression-free survival time(PFS)of CTC-positive patients were shorter compared to CTC-negative patients.In addition,CTC-positive patients had a more advanced TNM staging,poorer tumor differentiation,and earlier distant metastasis.A total of 59 patients were included in this study,and ROC curve analysis showed that the best cut-off value for I-CTC was 5,i.e.,≥5 was positive and <5 was negative.Positive I-CTC correlated with the degree of tumor differentiation(P<0.05).Positive I-CTC was associated with disease progression(P<0.05).16 of 59 patients received neoadjuvant chemotherapy.There were divided into PD(progressive disease)and DC(disease control)groups based on response to neoadjuvant chemotherapy.Patients in the I-CTC-negative group had longer OS and DFS than those in the positive group(P<0.05).Univariate analysis showed that the degree of tumor differentiation and I-CTC positivity were associated with OS in patients with gastric cancer(P<0.05).Multifactorial analysis revealed that I-CTC positivity(HR=13.323,95% CI [1.675,105.962],P=0.014)was an independent risk factor for survival in patients with locally progressive gastric cancer.Conclusion In the advanced gastric cancer,the prognosis and chemotherapy efficacy were worse in the I-CTC positive group than in the negative group,and interstitial CTC can be used as a valid marker to assess prognosis and chemotherapy efficacy.I-CTC can be used as an index to assess the efficacy of chemotherapy and prognosis of patients with advanced gastric cancer.The patients with advanced gastric cancer that I-CTC positive have poor prognosis. |
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